Provider Demographics
NPI:1912382045
Name:LOFSTROM, DANA (LMT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:LOFSTROM
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2204
Mailing Address - Country:US
Mailing Address - Phone:917-574-5696
Mailing Address - Fax:
Practice Address - Street 1:470 6TH ST
Practice Address - Street 2:STE C
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2920
Practice Address - Country:US
Practice Address - Phone:917-574-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21406225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist